Clinical and necropsy findings are described in 8 patients who lived 20-31 years (mean 24) after healing of a transmural acute myocardial infarct. Two had left ventricular aneurysms and one had both right and left ventricular infarcts. Survival for 2 decades or more after healing of a transmural acute myocardial infarct has rarely been documented and descriptions of hearts at necropsy in patients with well-documented infarcts 20 years or more earlier are virtually nonexistent.